CHESTNUT HEALTH SYSTEMS, INC. (NPI# 1043587348) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043587348 |
| Entity Type | Organization |
| Organization Name | CHESTNUT HEALTH SYSTEMS, INC. |
| Practice Address |
2148 Vadalabene Dr Maryville IL 62062-5632 |
| Practice Telephone | 6182883100 |
| Mailing Telephone | 6182883100 |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2020-05-12 |
| Authorized Official Name | MELISSA LYNN COOPER (MANAGED CARE SUPERVISOR) |
| Authorized Official Telephone | 3098203535 |
| Authorized Official Credential | LPN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251B00000X | Case Management | Agencies | ||
| N | 251S00000X | Community/Behavioral Health | 04023 | IL | Agencies |
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
04023 | IL | Ambulatory Health Care Facilities |
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
04023 | IL | Ambulatory Health Care Facilities |
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MENTAL HEALTH LICENSE | 04023 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992179642 | Chestnut Health Systems, Inc. | Substance Abuse Rehabilitation Facility | 110 Rottingham Ct, Suite B, Edwardsville, IL 62025-3788 | 2015-11-18 |
| 1770850075 | Chestnut Health Systems, Inc. | Clinic/Center | 648 State St Bldg B, Madison, IL 62060-1420 | 2011-11-30 |
| 1902184054 | Chestnut Health Systems, Inc. | Clinic/Center | 648 State St Bldg A, Madison, IL 62060-1420 | 2011-07-22 |
| 1194021485 | Chestnut Health Systems, Inc. | Case Management | 732 S Illinois St, Belleville, IL 62220-2142 | 2011-02-03 |
| 1346566445 | Chestnut Health Systems, Inc. | Community Based Residential Treatment Facility, Mental Illness | 814 Saint Louis Rd, Apt. 232, Collinsville, IL 62234-2023 | 2010-04-14 |
| 1245781079 | Chestnut Health Systems, Inc. | Substance Abuse Rehabilitation Facility | 1003 Martin Luther King Dr, Bloomington, IL 61701-1429 | 2016-10-17 |
| 1912371824 | Chestnut Health Systems, Inc. | Substance Abuse Rehabilitation Facility | 370 Houbolt Rd, Suite 101, Joliet, IL 60431-8303 | 2015-11-17 |
| 1003194150 | Chestnut Health Systems, Inc. | Clinic/Center | 3924 Oakmont Dr, Pontoon Beach, IL 62040-4395 | 2011-07-22 |
| 1558649608 | Chestnut Health Systems, Inc. | Case Management | 5109 N Illinois St, Apt. 101, Fairview Heights, IL 62208-3405 | 2011-07-22 |
| 1386922433 | Chestnut Health Systems, Inc. | Clinic/Center | 1218 19th St, Granite City, IL 62040-4501 | 2011-07-22 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | CHESTNUT HEALTH SYSTEMS, INC. | 1003 Martin Luther King Drive, Bloomington, IL 61701 |
| Washington State Corporations | CHESTNUT HEALTH SYSTEMS, INC. | 1003 Martin Luther King Dr, Bloomington, IL 61701 |
| Street Address |
2148 VADALABENE DR |
| City | MARYVILLE |
| State | IL |
| Zip Code | 62062-5632 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801002142 | Mackenzie R Pherigo | Social Worker | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2007-05-15 |
| 1699316877 | Terry Glenn | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2019-09-30 |
| 1144750605 | Rebecca Leigh Salah | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2017-06-18 |
| 1649726340 | William Michael Weiss I | Registered Nurse | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2016-09-01 |
| 1497115315 | Kolin Smith | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2016-03-04 |
| 1750740544 | Larry Copp | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2016-02-22 |
| 1750719142 | Courtney L Hupp | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2013-10-22 |
| 1568719797 | Daniel Douglas Hutchison | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2012-08-07 |
| 1952677510 | Tracey Sue Pearson | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2012-03-28 |
| 1518232891 | Jamie Lee Garman | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2012-03-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104325091 | Jennifer M Oyler | Physician Assistant | 6812 State Route 162 Suite 120, Maryville, IL 62062 | 2018-02-06 |
| 1710495965 | Sarah Elizabeth Barto | Family Medicine | 2133 Vadalabene Drive, Suite Sb, Maryville, IL 62062 | 2018-01-22 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1548657737 | Karen Michelle Bertels | Emergency Medicine | 6800 Il - 162, Maryville, IL 62062 | 2015-04-25 |
| 1811258148 | Debra Ann Hoelscher | Internal Medicine | 2102 Vadalabene, Maryville, IL 62062 | 2012-06-04 |
| 1538438445 | Casey Elizabeth Wiesemeyer | Speech-Language Pathologist | 2201 Copper Creek Rd, Maryville, IL 62062 | 2011-12-21 |
| 1407144819 | Norah Claire Farley Baker | Family Medicine | 10 Professional Park Dr., Maryville, IL 62062 | 2011-07-19 |
| 1891092474 | Kimberly M Schneider | Physician Assistant | 20b Professional Park Drive, Maryville, IL 62062 | 2011-02-17 |
| 1669782397 | Purandhri Patel | Physical Therapist | 6820 State Route 162, Maryville, IL 62062 | 2010-10-15 |
| Find all providers in zip 62062 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801821434 | Blount Memorial Hospital, Inc. | Clinic/Center | 451 Bmh Physician Office Bldg, Maryville, TN 37804-5807 | 2006-07-12 |
| 1427670819 | Christina Kittstein LLC | Clinic/Center | 6209 E Main St, Maryville, IL 62062-2015 | 2020-05-08 |
| 1699757609 | Parkwest Medical Center | Clinic/Center | 210 Simmons St, Maryville, TN 37801-4750 | 2005-11-16 |
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|---|---|---|---|---|
| 1225639990 | Mindy Forman, Psyd, LLC | Clinic/Center | 1020 Milwaukee Ave Ste 110, Deerfield, IL 60015-3555 | 2020-11-07 |
| 1346840295 | Stopka Professional Counseling LLC | Clinic/Center | 13125 Steeplechase Dr, New Lenox, IL 60451-1320 | 2020-10-29 |
| 1346848785 | Wellness Hearted Therapy LLC | Clinic/Center | 2675 S Cedar Glen Dr, Arlington Heights, IL 60005-5303 | 2020-10-16 |
| 1457959256 | Association for Individual Development | Clinic/Center | 708 N Bridge St, Yorkville, IL 60560-1105 | 2020-10-14 |
| 1285231555 | Association for Individual Development | Clinic/Center | 236 W Crystal Lake Ave, Crystal Lake, IL 60014-5847 | 2020-10-08 |
| 1386241123 | Envision Unlimited | Clinic/Center | 1801 N Spaulding Ave, Chicago, IL 60647-4926 | 2020-10-05 |
| 1881291789 | Jessica Weisbach, LLC | Clinic/Center | 2257 N Kedzie Blvd Apt 3, Chicago, IL 60647-2561 | 2020-10-04 |
| 1619574803 | Envision Unlimited | Clinic/Center | 2124 W 82nd Pl, Chicago, IL 60620-5358 | 2020-10-01 |
| 1144827320 | Envision Unlimited | Clinic/Center | 4919 N Clark St, Chicago, IL 60640-3514 | 2020-10-01 |
| 1194322370 | Envision Unlimited | Clinic/Center | 4911 S Hoyne Ave, Chicago, IL 60609-4721 | 2020-10-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.